Introduction – Cardiovascular Pharmacology

Vascular diseases are any abnormal conditions that affect the circulatory system and are responsible for more mortality and morbidity than any other category of human disease. The spectrum of pathology encompasses congenital and acquired disorders that are arterial, venous, capillary or lymphatic in origin. Vascular disease can affect virtually any vessel in the body and present with different symptoms in different regions of the body. The most commonly involved areas include the heart, head, neck, and upper and lower extremities. Less commonly, vessels supplying the bowel may be involved leading to bowel infarction.

00:06
Yes, hello! I’m Joseph Alpert with “Introduction
to Cardiology”. Today, we are going todo Part 6 which is the second in the series
of Cardiovascular Pharmacology.
00:19
The most important thing to remember in Cardiovascular
Pharmacology is what disease are we dealingwith or rather what diseases are we dealing
with.
00:29
Well, there’s one disease that’s exceedingly
common in the world. It’s relatively rarein countries without very much economic power,
but in countries with considerable economicgrowth and development, this disease becomes
increasingly common.
00:48
So, what is the leading cause of death in
the world? Is it Alzheimer’s disease? Isit accidents? Is it cancer? Well, let’s
think about that for a moment. In fact, it’snone of the above. Many millions of people
are affected by this disease. This diseaseis atherosclerosis - hardening of the arteries
in the layman’s term in English and it causesmore deaths than all of the previously mentioned
diseases. Alzheimer’s, accidents and cancerput together actually do not equal the number
of people who die from the complications ofatherosclerotic disease.
In fact, in the United States, one in threedeaths is the result of atherosclerotic disease
and there’s one death every 30 seconds inthe US from this disease.
Now, it affects different organs, it affectsmost commonly the heart causing heart attacks
or myocardial infarctions. It can cause suddendeath and frighteningly, the first manifestation
of atherosclerosis of the coronary diseaseis often sudden death.
In cardiology, we refer to it as coronaryartery disease because those are the arteries
affected that lead to myocardial infarctionor heart attack and the abbreviation CAD for
“Coronary Artery Disease” is frequentlyused. It is the number one killer in the United
States and it is now the number one killerin the world as many countries have moved
from lower economic development phases intomore western and highly technical developments.
The disease comes along with the western lifestyle.
02:41
And of course, here, again, the point is made
that it is the commonest cause for death inthe United States, in Western Europe and now,
in many parts of Asia, it has also becomethe commonest cause of death.
So, what is the cause of atherosclerosis?Well, there are multiple factors. I think
most people have heard from the media thatit’s a variety of things. Cigarette smoking,
high blood pressure, a whole variety of factorsplay a role in the development of hardening
of the arteries, but the most important elementis elevated blood cholesterol.
When we examine blood cholesterol in natives,for example, in the highlands of New Guinea,
who are healthy and eating well, it is onethird the value that you see in Western Europe
and the United States.
03:38
In fact, in the United States, we estimate
that approximately 50% of the population hasa cholesterol value that is too high. And,
it is this high level of cholesterol oftencombined with other factors such as smoking
or high blood pressure or diabetes that leadsto atherosclerosis. The disease unfortunately
starts in childhood and then can rapidly progressdepending upon the presence of other risk
factors and usually, affects people in themiddle of their life at ta time when they
are most productive. And as I have said before,the most frightening and disconcerting symptom
is sudden death, which in 50% of people, isthe first manifestation of coronary disease.
We are going to have a whole lecture on coronarydisease later in this series, but it’s important,
in terms of understanding what drugs we haveand what drugs have been developed, to understand
what disease we are frequently dealing with.
04:38
Well, let’s talk a little bit about elevated
lipids or elevated fats in the blood. Themedical term is hyperlipidemia. “Hyper”
in Greek means “large” or “increased”and “lipidemia” means “lipid” or “fats
in the blood stream”. This is high levelsof variety of fats in the blood stream.
When we talk about lipids on a clinical basis,we usually refer to four commonly measured
lipids. Now, there are a number of others thatare particularly useful in various research
projects. But at the moment, the ones we concentrateon are total blood cholesterol, LDL cholesterol -
so called low density lipoprotein cholesterol,HDL cholesterol - also called high density
lipoprotein cholesterol, and triglycerides.
05:33
Let’s talk just a little bit about them
for a moment because then you can see, we aregoing to be talking about drugs for controlling
hyperlipidemia to prevent… or heart diseasein the first place, in people who are at high
risk or in fact, to treat them once they havedeveloped heart disease in an attempt to prevent
the disease from progressing.
05:56
So, the point about high fats that’s important
to remember is that there are other componentsin the blood stream beside those, but in the
daily clinical activities, we measure thefour that were just mentioned. Again, these
are the lipids that lead to atherosclerosisand atherosclerosis can lead to myocardial
infarction or heart attack or stroke or kidneyfailure or even heart failure.
So, you see the… all of these processesstart with levels of cholesterol and triglycerides,
but mostly, cholesterol in the blood thatare too high. In fact, the higher your blood
cholesterol, the greater your risk of havinga myocardial infarction or even dying of a…
a heart attack or the complications of a heartattack. You will notice from this curve, as
we look on the bottom - as total blood cholesterolrises, moving from left to right, you will
see that there is an increase in the manifestationsof coronary disease including heart attacks,
strokes and death.
07:15
So, let’s about each of these individual
forms of cholesterol and then we are goingto talk about the therapy which is now available
for them.

About the Lecture

The lecture Introduction – Cardiovascular Pharmacology by Joseph Alpert, MD is from the course Introduction to the Cardiac System.

Included Quiz Questions

Which of the following is the largest killer of non-communicable disease?

Coronary artery disease

Alzheimer's disease

Stroke

Road accidents

Tuberculosis

Which of the following is NOT a common entity measured in coronary artery disease?

Intermediate density cholesterol

Total cholesterol

LDL cholesterol

HDL cholesterol

Triglycerides

Author of lecture Introduction – Cardiovascular Pharmacology

Joseph Alpert, MD

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